Commercial Auto
Insurance Quote Request

McAlister Gray Agency

3617 E Southern Ave #1A
Mesa, AZ 85206
(800) 863-2501
(480) 621-6400
(480) 807-1477 (Fax)
email: info@mcalistergray.com

Our rates are based on a credit scoring methodology. To provide the most accurate rates, it is necessary to run the credit scoring check.
Please provide the following information:

Name

Street address

Address (cont.)

City

State

Zip/Postal code

Home Phone

Work Phone

E-mail

Do you own a business?

Type of business:

Date Business Established:

Dun & Bradstreet Listed Business Name:

Present Auto Liability Company

How Long Insured?
Expiration Date

Number of Drivers in Company

Owner/Partner/CEO personal Credit History

Name:

Date of Birth:

Social Security Number:

Driver Information

Name	Birth Date	Marital Status	# of Accidents in last 3 years	# of Violations in last 3 years	List Violations and Dates	Filings Required?	List Type

Vehicle Information

Commercial Usage: Describe Use of Vehicle	Any Personal Use?	Year	Make	Model	Gross Vehicle Weight (not registered weight)	No. of Axles or Passengers	Radius of Operation	Vehicle Stated Value	VIN	Garaging Zip Code

Coverage Information

Coverage Type	Auto 1	Auto 2	Auto 3	Auto 4	Auto 5	Auto 6
BI
PD
UM
UIM
Medical Payments
Comprehensive (or F&T w/CAC
Collision
On-Hook Towing
Non-Trucking (Bobtail)
Glass
Acc Death

Comments

Our rates are based on a credit scoring methodology. To provide the most accurate rates, it is necessary to run the credit scoring check. Please provide the following information:
Name
Street address
Address (cont.)
City
State
Zip/Postal code
Home Phone
Work Phone
E-mail
Do you own a business?
Type of business:
Date Business Established:
Dun & Bradstreet Listed Business Name:
Present Auto Liability Company
How Long Insured?
Expiration Date
Number of Drivers in Company
*Owner/Partner/CEO personal Credit History*
Name:
Date of Birth:
Social Security Number: